AB0209 VALIDATION OF REVISED 2022 ACR/EULAR REMISSION CRITERIA FOR RHEUMATOID ARTHRITIS IN ASIAN INDIAN RHEUMATOID ARTHRITIS PATIENTS
Authors: C. B. Prasad, V. Dhir, G. Naidu, S. K. Sharma, A. Sharma, S. Jain
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Remission has become a key target in the management of rheumatoid arthritis (RA) patients<sup>[1]</sup>. In 2022, American College of Rheumatology (ACR) and European League Against Rheumatism (EULAR) has revised the Boolean based remission criteria in RA by increasing the patient global assessment of disease activity (PtGA) threshold to ≤2cm (range 0–10 cm). This has not been validated in an Asian Indian cohort of RA patients<sup>[2,3]</sup>. <h3>Objectives</h3> To validate ACR/EULAR remission criteria for RA: 2022 revision in Asian Indian RA patients by using data of an ongoing clinical trial. <h3>Methods</h3> For the purpose of validating the remission criteria, data generated at our center from an ongoing clinical trial (SMART study) which enrolled patients with active seropositive RA, who were 18-60 years old with disease duration ≤5 years was used. This is a 24-week multicenter, open-label RCT to compare efficacy of split versus non-split doses of methotrexate (MTX). For this analysis, data from both groups was analyzed together. Patients are started on oral MTX 15 mg/week which was escalated every two weeks by 5 mg, to reach a maximum dose of 25 mg/week by 4 weeks. At the end of 16 weeks, if Disease Activity Score 28 (DAS28) &gt;3.2 another DMARD can be added. Disease activity was measured using the DAS28, Simplified Disease Activity Index (SDAI) and Clinical Disease Activity Index (CDAI) at 24 weeks. Proportion of patients achieving remission with index-based (SDAI≤3.3 &amp; CDAI≤2.8) and ACR/EULAR Boolean-based criteria was compared. The proposed PtGA threshold of 2 cm (Boolean2.0) (range 0–10 cm) was compared with the original threshold of 1 cm (Boolean1.0) as well as with 1.5 cm, 2.5 cm and no PtGA (Boolean X) for remission. Agreement (Cohen's kappa) was assessed between Boolean-based and index-based criteria. <b>#</b>Trial registration number: <b>CTRI/2021/02/031361</b>. <h3>Results</h3> This study included 125 patients, majority being females (105 (84%)), with mean (±SD) age of 42.8 (±10.8) years and mean (±SD) disease duration of 2 (±1.5) years. At 24-weeks, using the index based (SDAI and CDAI) criteria, remission was achieved in 24.8% and 24% of patients respectively. Among the various Boolean criteria, remission occurred in only 21.6% using the original Boolean1.0. This increased with Boolean2.0 to 23.2%, and further increased with Boolean2.5 and Boolean X [Figure 1]. The highest agreement between SDAI or CDAI-defined remission was found to occur with Boolean2.0-defined remission rather than Boolean1.0 (or 1.5, 2.5 or X) defined remission [Table 1]. Also, there was strong agreement (0.89 (95% CI 0.79-0.99)) between SDAI and CDAI-defined remission criteria. <h3>Conclusion</h3> We validated the performance of revised 2022 ACR/EULAR remission criteria for RA in Asian Indian RA patients and found the higher agreement of Boolean2.0 (rather than Boolean1.0) with index-based remission cutoffs. <h3>References</h3> [1]Fraenkel L, Bathon JM, England BR, et al. 2021 American College of rheumatology guideline for the treatment of rheumatoid arthritis. Arthritis Rheumatol 2021;73:1108–23. [2]Studenic P, Aletaha D, de Wit M, et al. American College of Rheumatology/EULAR remission criteria for rheumatoid arthritis: 2022 revision. Ann Rheum Dis 2023;82(1):74-80. [3]Studenic P, Aletaha D, de Wit M, et al. American College of Rheumatology/EULAR Remission Criteria for Rheumatoid Arthritis: 2022 Revision. Arthritis Rheumatol 2023;75(1):15-22. <h3>Acknowledgements</h3> None. <h3>Disclosure of Interests</h3> None Declared.